In hypertensive patients with elevated risk of cardiovascular disease, targeting systolic blood pressure to less than 120 mm Hg significantly reduces the rate of fatal and non-fatal cardiovascular events as well as death from any cause

Rationale and Objective: In the Systolic Blood Pressure Intervention Trial, the possible relationships between acute kidney injury (AKI) and risk of major cardiovascular events and death are not known. Study Design: Post hoc analysis of a multicenter, randomized, controlled, open-label clinical trial. Setting and Participants: Hypertensive adults without diabetes who were ≥50 years of age with prior cardiovascular disease, chronic kidney disease (CKD), 10-year Framingham risk score > 15%, or age > 75 years were assigned to a systolic blood pressure target of < 120 mm Hg (intensive) or < 140 mm Hg (standard). Predictor: AKI episodes. Outcomes: The primary outcome was a composite of myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or cardiovascular death. The secondary outcome was death from any cause. Analytical Approach: AKI was defined using the Kidney Disease: Improving Global Outcomes modified criteria based solely upon serum creatinine. AKI episodes were identified by serious adverse events or emergency room visits. Cox proportional hazards models assessed the risk for the primary and secondary outcomes by AKI status. Results: Participants were 68 ± 9 years of age, 36% women (3,332/9,361), and 30% Black race (2,802/9,361), and 17% (1,562/9,361) with cardiovascular disease. Systolic blood pressure was 140 ± 16 mm Hg at study entry. AKI occurred in 4.4% (204/4,678) and 2.6% (120/4,683) in the intensive and standard treatment groups respectively (p < 0.001). Those who experienced AKI had higher risk of cardiovascular events (hazard ratio [HR] 1.52, 95% CI 1.05–2.20, p = 0.026) and death from any cause (HR 2.33, 95% CI 1.56–3.48, p < 0.001) controlling for age, sex, race, baseline systolic blood pressure, body mass index, number of antihypertensive medications, cardiovascular disease and CKD status, hypotensive episodes, and treatment assignment. Limitations: The study was not prospectively designed to determine relationships between AKI, cardiovascular events, and death. Conclusions: Among older adults with hypertension at high cardiovascular risk, intensive treatment of blood pressure independently increased risk of AKI, which substantially raised risks of major cardiovascular events and death.

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[PP.05.06] IN DIABETIC PORTUGUESE HYPERTENSIVE PATIENTS LOWERING NIGHT SYSTOLIC BLOOD PRESSURE IS ASSOCIATED WITH LESS CARDIOVASCULAR EVENTS IN A PORTUGUESE SAMPLE OF TREATED HYPERTENSIVES PATIENTS FOLLOWED FOR 11,8 ± 5,1 YEARS

Journal of Hypertension ◽

10.1097/01.hjh.0000491718.85692.e6 ◽

2016 ◽

Vol 34 ◽

pp. e141

Author(s):

A. Araújo ◽

P. Almeida ◽

J. Pinto ◽

J. Pires ◽

I. Zão ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Cardiovascular Events ◽

Hypertensive Patients

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Effect of Self-monitoring and Medication Self-titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease

JAMA ◽

10.1001/jama.2014.10057 ◽

2014 ◽

Vol 312 (8) ◽

pp. 799 ◽

Cited By ~ 185

Author(s):

Richard J. McManus ◽

Jonathan Mant ◽

M. Sayeed Haque ◽

Emma P. Bray ◽

Stirling Bryan ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

High Risk ◽

Systolic Blood Pressure ◽

Self Monitoring ◽

Hypertensive Patients

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Abstract 16532: Impact of Systolic Blood Pressure on Cardiovascular Disease in a Chinese Population: A Mendelian Randomization Study

Circulation ◽

10.1161/circ.130.suppl_2.16532 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Robert Clarke ◽

Liming Li ◽

Derrick Bennett ◽

Iona Y Millwood ◽

Robin G Walters ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Systolic Blood Pressure ◽

Cardiovascular Events ◽

Mendelian Randomization ◽

Haemorrhagic Stroke ◽

Candidate Snps ◽

Genetic Score ◽

Relative Risks ◽

Major Cardiovascular Events

Aims: To investigate the quantitative importance of systolic blood pressure (SBP) for cardiovascular disease using a Mendelian randomization analysis and compare the risk associations with equivalent differences in standard measures of SBP after correction for regression dilution. Methods: In the China Kadoorie Biobank prospective study, 82,373 unrelated adults aged 30-79 years had SBP recorded and were genotyped for 384 candidate SNPs, including 32 SNPs previously associated with blood pressure. These SNPs were combined to generate a genetic score for SBP (GS-SBP) and estimate the associated relative risks (RR) and 95% confidence intervals (CI) of major cardiovascular events (stroke, and non-fatal MI or IHD death). The results were compared with the RRs for 20 mmHg higher SBP before and after correction for regression dilution (basal or usual SBP).The correlation coefficient between replicate measurements of SBP between baseline and a re-survey after 3 years was 0.6 and was used to correct for regression dilution. Results: The overall mean (SD) age at survey was 51 (10.7) years and mean (SD) SBP was 131.9 (22.2) mmHg, but only 4.8% reported use of any anti-hypertensive treatment. Overall, there was a 5 mmHg difference in the mean SBP between the top and bottom fifths of the GS-SBP. After adjustment for regression dilution, each 20 mmHg higher usual SBP was associated with RRs of 1.78, 2.45, 1.61, and 1.84 for ischaemic stroke, haemorrhagic stroke, non-fatal MI or IHD death and major cardiovascular events, respectively (Table). For GS-SBP, the corresponding RRs were much more extreme, being 2.48, 2.85, 1.85 and 2.69, respectively. Conclusions: This Mendelian randomization study demonstrates that the effects of long-term differences in SBP for risk of major cardiovascular events in this largely untreated population were almost 50% greater than those estimated for standard measures of SBP after correction for regression dilution.

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Blood pressure levels and cardiovascular risk according to age in patients with diabetes mellitus: a nationwide population-based cohort study

Cardiovascular Diabetology ◽

10.1186/s12933-020-01156-8 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Hack-Lyoung Kim ◽

Hyue Mee Kim ◽

Chang Hee Kwon ◽

Jeong-Hun Shin ◽

Mi-Hyang Jung ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Events ◽

Cardiovascular Death ◽

Population Based ◽

Hypertensive Patients ◽

Patients With Diabetes ◽

History Of

Abstract Background Little is known about age-specific target blood pressure (BP) in hypertensive patients with diabetes mellitus (DM). The aim of this study was to determine the BP level at the lowest cardiovascular risk of hypertensive patients with DM according to age. Methods Using the Korean National Health Insurance Service database, we analyzed patients without cardiovascular disease diagnosed with both hypertension and DM from January 2002 to December 2011. Primary end-point was composite cardiovascular events including cardiovascular death, myocardial infarction and stroke. Results Of 241,148 study patients, 35,396 had cardiovascular events during a median follow-up period of 10 years. At the age of < 70 years, the risk of cardiovascular events was lower in patients with BP < 120/70 mmHg than in those with BP 130–139/80–89 mmHg. At the age of ≥ 70, however, there were no significant differences in the risk of cardiovascular events between patients with BP 130–139/80–89 mmHg and BP < 120/70 mmHg. The risk of cardiovascular events was similar between patients with BP 130–139/80–89 mmHg and BP 120–129/70–79 mmHg, and it was significantly higher in those with BP ≥ 140/90 mmHg than in those with BP 130–139/80–89 mmHg at all ages. Conclusions In a cohort of hypertensive patients who had DM but no history of cardiovascular disease, lower BP was associated with lower risk of cardiovascular events especially at the age of < 70. However, low BP < 130–139/80–89 mmHg was not associated with decreased cardiovascular risk, it may be better to keep the BP of 130–139/80–89 mmHg at the age of ≥ 70.

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EFEKTIVITAS PEMBERIAN HYDROTHERAPI RENDAM KAKI PADA PENDERITA HIPERTENSI DI BANJAR SRI MANDALA, KELURAHAN DAUHWARU KABUPATEN JEMBRANA

JURNAL WIDYA BIOLOGI ◽

10.32795/widyabiologi.v10i01.235 ◽

2019 ◽

Vol 10 (01) ◽

pp. 33-44

Author(s):

N.L.G. Sudaryati ◽

I P. Sudiartawan ◽

Dwi Mertha Adnyana

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Pressure Measurement ◽

Blood Pressure Measurement ◽

Reduce Blood Pressure ◽

Second Grade ◽

Control Group ◽

Hypertensive Patients ◽

First Category

The aim of the study was to determine the effectiveness of giving hydrotherapi foot soak in hypertensive patients. The study was conducted with one group pretestposttest design without a control group by measuring blood pressure (pretest) before being given an intervention in the form of foot soak hydrotherm against 15 people with hypertension in Banjar Sri Mandala, Dauhwaru Village, Jembrana Subregency. Then do the blood pressure measurement again (posttest) after finishing the intervention. After the study was completed, the results showed that before the hydrotherapi foot bath intervention, there were 0% of patients classified as normal, 13.32% in prehypertension category, 60.08% in hypertension category I and 26.60% in hypertension category II. After the intervention was given, there were 13.32% of the patients classified as normal, 66.68% in the prehypertension category, 20.00% in the first category of hypertension and no patients belonging to the second grade hypertension category. There is a decrease of 20-30 mmHg for systolic blood pressure and 0-10 mmHg for diastolic blood pressure after intervention. Based on the results of the study it can be concluded that the hydrotherapi foot bath is effectively used to reduce blood pressure in hypertensive patients in the Banjar Sri Mandala, Dauhwaru Village, Jembrana District.

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ASSESSING THE OUTCOMES OF TREATMENT AND MANAGEMENT, 400 HYPERTENSIVE PATIENTS IN BONG SON GENERAL HOSPITAL, BINH DINH PROVINCE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.1.4 ◽

2016 ◽

pp. 31-40

Author(s):

Long Nhon Phan ◽

Van Minh Huynh ◽

Thi Kim Nhung Hoang ◽

Van Nham Truong

Keyword(s):

Blood Pressure ◽

Risk Stratification ◽

Hypertensive Patient ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Blood Pressure Target ◽

Average Risk ◽

Hypertensive Patients ◽

Average Systolic Blood Pressure ◽

Complications Of Stroke

Objective: To evaluate the results of treatment achieved blood pressure goal (BP goal) and results of hypertensive patient management. Subjects and methods: A study of 400 hypertensive patient intervention, treatment and management after 2 year. To assess the results of BP target, monitor the use of medicines, the situation of hospitalization and complications of stroke. Results: Treatment: -100% of patients using diuretics and angiotensin-converting enzyme inhibitors (ACEIs), 33% of patients using angiotensin receptor blockers (ARBs), 46.25% of patients using calcium channel blockers (CCBs) and 19.5% of patients using beta-blocker. After 24 months of treatment: 50.5% of patients using 1 antihypertensive drug, 22% of patients using 2 drugs, 20.5% of patients using 3 drugs and 7% of patients taking more than 3 drugs. After 24 months of treatment: 91.75% achieved BP target and 8.25% fail. -Average risk stratification: 97.32% achieved BP target, hight risk stratification: 95.91% and very hight risk stratification: 73.03%. After 24 months of treatment. -Stage 1: 88.48% achieved BP target, stage 2: 92.85% achieved BP target and stage 3: 71.08% achieved BP target. After 24 months of treatment. -Hypertesive results before treatment were: 159.80 ± 20,22mmHg average systolic blood pressure and 82.97 ± 5,82mmHg average diastolic blood pressure. After treatment: average systolic blood pressure 125.38 ± 6,88mmHg and average diastolic blood pressure 79.83 ± 1,79mmHg. No adverse change in the index of tests about lipidemia, liver, kidney, glucomia and no recorded cases of drug side effects. Management of patients: -There were 89% non-medical examinational patients 1 month, 5.25% non-medical examinational patients 2 months, 4.25% non-medical examinational patients 3 months and 1.5% non-medical examinational patients 4 months. There were 93.5% drop pill 1 month, 3.25% drop pill 2 months, 4.25% drop pill 3 months and no patient drop pill over 3 months. In 24 months follow-up, 47% hospitalized inpatients <5 times, 44.5% hospitalized inpatients 5-10 times, 3% hospitalized inpatients 11-15 times, 4.75% hospitalized inpatients from 16-20 times and 0.75% hospitalized inpatients > 20 times. -There were 32.75% hospitalized inpatients for reasons of hypertension and 63.75% hospitalized inpatients for other common diseases. -There were a total of 11592 contacts directly by phone for medical advice, medical reminders and examinational reminders during 24 months of management. -There were 0.5% of patients stroked during 24 months of treatment and management. Conclusion: Treatment by protocol and management by phone directly for medical taking and re-examinational reminders is the best resulted method of achieving blood pressure target and reducing complications of stroke for hypertensive patients. Key word: : blood pressure target; risk stratification; treatment; management; stage; phone.

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